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Is menopause being over-medicalised?
The authors of a landmark investigation are demanding a new approach, but outside experts warned against shifting too far from established treatments.
The typical age at menopause is around 50 years old, with around 12% of women experiencing the condition earlier.
It is a healthy part of ageing for half of the world’s population, but menopause has long been a taboo subject, hidden by generations of silence.
Now, a coalition of Australian researchers is working to bring menopause out of the shadows – arguing for a societal change and a mindset shift for GPs.
Through a high-profile series published in The Lancet, the group is arguing menopause has suffered from an ‘over-simplified narrative’ and is perceived as a ‘health problem to be solved by replacing hormones’.
It calls for a new approach to menopause management, which empowers women to access high-quality information about symptoms and treatments, empathic clinical care, and workplace adjustments.
‘Rather than focusing on menopause as an endocrine deficiency, we propose an empowerment model that recognises factors modifying the experience,’ the paper said.
The series outlines four key areas of change:
- An empowerment model for managing menopause
- Optimising health after early menopause
- Promoting good mental health over the menopause transition
- Managing menopause after cancer
According to the series’ co-author, University of Melbourne Professor Martha Hickey, there is a long-held misconception that menopause leads to a decline in physical and mental health.
She said this must be challenged across the whole of society, including by healthcare professionals.
‘Changing the narrative to view menopause as part of healthy ageing may better empower women to navigate this life stage and reduce fear and trepidation amongst those who have yet to experience it,’ Professor Hickey said.
‘Our series calls for an individualised approach where women are empowered with accurate, consistent, and impartial information to make informed decisions which are right for them over the menopause transition.’
The series said there has been a global tendency to focus only on the negative experiences of menopause, depicting it as an ‘unfortunate and distressing experience’.
Series co-author Dr Lydia Brown said while some women go through an extremely negative experience, it is not guaranteed.
‘The reality is much more complex and varied, with some women reporting neutral experiences and others highlighting good aspects, such as freedom from menstruation and menstrual pain,’ she said.
The researchers are now calling out healthcare professionals, saying they need to ensure patients have the knowledge to make informed decisions around menopause.
The typical age at menopause is around 50 years old, with 12% of women globally experiencing menopause between the ages of 40 and 44.
The paper states that women who enter menopause at younger ages can feel distress and less supported, and there is a gap in clinical guidance for early menopause.
For this reason, co-author Dr Andrea La Croix said it is important that information about treatments, their benefits, risks, and comparative effectiveness are made readily available to all women.
‘[Menopausal hormone therapy] MHT is the best-known medication and data suggests it’s slightly more effective than alternative medications for treating hot flushes and night sweats,’ she said.
‘However, no medication can reliably resolve all negative experiences during menopause and commercial interests have influenced how MHT is presented – overshadowing evidence-based alternative options.’
The research also suggests new strategies are needed to promote good mental health throughout the menopause transition, while responsibly preparing and supporting those at risk.
More supportive and inclusive workplace cultures are another area for improvement, with studies finding women want their managers to be informed and empathetic about menopause.
The investigation has garnered the attention of experts from across the globe.
National Association of Specialist Obstetricians and Gynaecologists President Associate Professor Gino Pecoraro has welcomed the more open discussion about menopause.
But he warns that doctors must be careful ‘not to undo any good that has already been done’.
‘No doctor treating a woman suffering from menopausal symptoms would deny the role of empowerment and non-pharmacological treatments to help sufferers better deal with this transition,’ he said.
‘However, there remains a place for symptom control with hormonal and non-hormonal medical therapies.
‘Rather than trying to pitch one model of treatment over another, wouldn’t it be great if women and their doctors were aware of all treatment options and individualise treatment to the particular needs of each woman seeking their help?’
Meanwhile, the Director of Monash University’s Women’s Health Research Program, Professor Susan Davis, said it is disappointing that health empowerment has not already been applied to menopause.
She said empowering women to best navigate menopause through the provision of credible health information to support informed and shared decision-making, has been the focus of national and international organisations for many years.
‘The authors caution against “over-medicalisation” of the menopause but the messaging regarding [hormone] therapy is mixed, and potentially confusing,’ Professor Davis said.
‘The authors seem determined to minimise the important role of MHT in helping many women as they reach menopause.
‘They ignore other published systematic reviews which all agree that MHT is the most effective treatment for vasomotor symptoms, is as effective as other bone-specific therapies [antiresorptive agents] in reducing post-menopausal osteoporosis and associated fractures.’
But in conclusion, the authors said society must shift its view on women in mid-life, and appreciate their contributions and skills, especially in the workforce.
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